The placenta is an oval, flat shaped organ that provides the developing fetus with oxygen and nutrients from the mother’s circulatory system (Ricci and Kyle, 2008). It also aids in the removal of waste products from the developing fetus to the mother’s circulatory system. The placenta begins to form immediately after conception. It is attached to the walls of the uterus and the umbilical cord of the developing baby arises from it. The National Institutes of Health, (2010), makes it clear that the placenta forms a vital link between the mother and the developing fetus.
The placenta, just like other body organs, is prone to a variety of complications. One of these complications is the placenta previa. Placenta previa, according to Azziz (2006), is a rare complication that occurs during pregnancy, which results in excessive bleeding before, during or after delivery. This condition occur when the placenta is inappropriately attached to the lower region of the uterine wall thereby completely or partially blocking the cervix. Placenta Previa Even though placenta previa is a rare condition, its occurrence leads to significant maternal and prenatal morbidity in addition to mortality.
It is one of the major factors that result in excessive vaginal bleeding during the second and the third trimesters (National Institutes of Health, 2010). Bleeding is usually painless and bright red. However, it may be accompanied with some irritability. During the initial stages, bleeding is not very severe and cannot cause death. It spontaneously ceases and recurs at a later stage of pregnancy. The first bleeding may be detected after about 27 weeks of pregnancy (Goodwin, Montoro and Muderspach, 2010). Bleeding may or may not be accompanied by contractions. Placenta previa is not a major problem during early stages of pregnancy.
It is however, a serious pregnancy complication during the late stages of pregnancy. It may result in early delivery in addition to other complications (Ricci and Kyle, 2008). Excessive bleeding occurs during the third trimester due to the fact that the lower third of the uterus becomes thin and stretches during the last trimester in order to give room for the developing fetus in addition to preparation for delivery (Azziz, 2006). The thinning and stretching of the uterine wall result in tearing of the margins of the low lying placenta and subsequent bleeding.
As pregnancy comes to term, the cervix starts softening and changes its shape as it prepares for delivery. It also shortens and starts dilate. These changes in cervical structure may occur a few weeks before delivery. In previa position, numerous problems are experienced during cervical movements. As the cervix begins to dilate, it detaches itself from the placenta attachment sites that are blood filled on top of it. This causes the mother to bleed profusely (National Institutes of Health, 2010). There are various types of placenta previa.
These include: Absolute placenta previa, which is said to have occurred when the placenta completely covers the internal cervical os; partial placenta previa, which is said to have occurred when the placenta partially covers the internal cervical os; low lying placenta previa which occurs when the placenta is inappropriately implanted in the lower region of the uterine wall; and marginal placenta previa which occurs when the margin of the internal os is covered by the placenta (Ricci and Kyle, 2008). The main cause of placenta previa is not yet known. Various factors are however, believed to be the major causes of placenta previa.
These factors include: advanced maternal age, previous caesarian delivery or deliveries, multiple pregnancy, previous abortion, and smoking (Jocoy, 2010). Use of hard drugs such as cocaine is also linked to development of placenta previa. Occurrence of placenta previa is also high in women who have abnormally developed uterus. Attachment of the embryonic plate to the lower segment of the uterus is the first step in development of placenta previa (Goodwin, Montoro and Muderspach, 2010). After attachment the placenta continues to grow and partially or completely covers that internal cervical os.
Inappropriate implantation results in defective decidual vascularization over the cervix. Defective vascularization occurs as a result of atrophic changes of the uterine wall. In a research conducted by Yang, Wen, Oppenheimer, Chen, Black, Gao, and Walkera, (2007), it was revealed that caesarian delivery is one of the major risk factors associated with placenta previa in subsequent pregnancies. A Meta-analysis conducted by Yang, et al (2007), also revealed that women who had gone through caesarian delivery had a higher risk of developing placenta previa during subsequent pregnancies.
Nevertheless, the evidence of caesarian section delivery, as a major risk factor of placenta previa, is inconsistent. Yang et al (2007), state that only a few studies have explored the link between caesarian delivery and placenta previa during subsequent pregnancies. However, as stated by Jocoy (2010), it is highly likely that caesarian section delivery may result in placenta previa in subsequent pregnancy due to the fact that scars in the lower regions of the uterus may result in inappropriate placental attachment.
Tying of uterine blood vessel with a ligature to prevent bleeding during caesarian section delivery augments the risk of harm to the myometrial and endometrial uterine lining (Goodwin, Montoro and Muderspach, 2010). This may result in placenta previa in subsequent pregnancy. The risk of developing placenta previa is high among women who are above the age of thirty years as compared to those who are below that age. Previous research, as indicated by Yang, et al (2007), has it that placenta previa in the U. K occurs in 0. 28% of all live births. Maternal mortality rate as a result of placenta previa in the United Kingdom is about 0.
03% (Yang et al, 2007). Mothers presenting with placenta previa tend to give birth to babies who weigh less as compared to those of normal mothers. Mortality rate among neonates is higher among placenta previa babies as compared to those born of mothers without the complication. Goodwin, Montoro and Muderspach (2010), state that many of these deaths occur as a result of uterine bleeding in addition to the complication of disseminated intravascular coagulopathy. There are numerous adverse complications associated with placenta previa. These include: placenta abruptio, anemia and decrease in total maternal blood volume.
Anemia and decrease in total maternal blood volume occur as a result of increased loss of blood. However, they can be corrected through blood transfusion (Goodwin, Montoro and Muderspach, 2010). Placenta previa also results in retardation of intrauterine growth. Numerous congenital anomalies may also arise from placenta previa. Placenta abruptio also referred to as abruptio placentae is a condition whereby the placenta abruptly breaks off from the attachment site on the uterine wall before the fetus is delivered (Goodwin, Montoro and Muderspach, 2010).
There are two types of abruptio placentae: partial and total abruptio placentae. Absolute abruptio placentae results in the death of the fetus whereas in partial abruptio placentae, pregnancy may continue to term. Premature delivery as a result of placenta previa may result in respiratory distress syndrome (Jocoy, 2010). However, mortality rates as a consequence of respiratory distress syndrome have currently been reduced due to use of advanced technology in neonatal intensive care facilities. The survival rate of babies presenting with respiratory distress syndrome is higher in the modern world as compared to the past.
Nevertheless, some babies presenting with this condition still die at an early age. Babies born of mothers presenting with placenta previa have a higher risk to developing jaundice at birth as compared to those born of normal mothers (Azziz, 2006). This is because babies of placenta previa mothers tend to lose blood along with the mother. At times, the loss of blood may be so critical that transfusion has to be carried out shortly after birth in order to save the baby (Ricci and Kyle, 2008). Diagnosis of placenta previa is carried out using ultrasound scanning.
Vaginal exams cannot be conducted until placenta previa has been ruled out through ultrasound scanning. Transdermal ultrasound is carried out to confirm suspicion of placenta previa. Transperineal or transvaginal ultrasound may be conducted if transdermal ultrasound does not produce clear visualization of the link between the internal os and the placenta (Azziz, 2006). Azziz (2006), states that the first sign of placenta previa is painless bright red vaginal bleeding during the late second trimester as well as the third trimester. False positive diagnosis may however, be made as a result of overfilling of the bladder.
False negative diagnosis may also be made as a result of missing the previa that may be located behind the head of the baby (Azziz, 2006). There are some other signs besides vaginal bleeding that may indicate presence of placenta previa. These include: premature contractions, abnormal growth and presentation of the uterus. Nursing care specific to clients presenting with placenta previa comprises of: examination for signs and symptoms of vaginal bleeding, laboratory tests, and client psychological education (Buckley, 2003), in addition to supportive care (Littleton and Engebretson, 2005).
Frequent check of the perineum for bleeding is conducted every time a client presenting with placenta previa defecates or urinates. Careful monitoring of the developing fetus and the mother can be a major step in preventing dangers that may emanate from placenta previa (Littleton and Engebretson, 2005). Cases of excessive bleeding should be reported to the physician in charge. Recreational and occupational therapy may be conducted for women who need prolonged hospitalization. Skin assessment in addition to focusing attention to hygiene of women, to whom total bed rest has been prescribed, should also be carried out.
It is important that information concerning the proposed plan of care be given to family members of a client presenting with placenta previa. Littleton and Engebretson (2005) state that the probable complications that may emanate from this condition should also be outlined and presented to responsible family members of the client. Emergency situations may arise whereby a pregnant woman may experience vaginal bleeding with no prior warnings. Such an emergency case is traumatizing to both the pregnant woman and the other family members (Buckley, 2003).
Nurses are therefore required to prepare the pregnant mother and the family members for an event like this one. Nurses provide the client with details that are vital to preparation for a caesarian section and also offer reassurance to the client in case caesarian section is carried out (Littleton and Engebretson, 2005). Placenta previa is a condition that can be treated. In early stages of pregnancy, placenta previa may correct itself without any medical intervention as a result of the enlargement of the uterus.
However, treatment of this condition depends on the presence and amount of bleeding a mother is experiencing in addition to the stage at which the pregnancy is (Goodwin, Montoro and Muderspach, 2010). If a mother is experiencing severe loss of blood, delivery is induced in spite of the gestational age of the fetus. Frequent transfusions and resuscitations are also carried out in case of excessive hemorrhage. An emergency caesarian section delivery, as stated by Oliver (2000), is carried out in order to minimize further loss of blood that may arise from disruption of placenta during normal delivery.
Even in the absence of bleeding, caesarian section delivery is the most appropriate for mothers presenting with placenta previa (Oliver, 2000). However, the degree in addition to the severity of the placenta previa is among the major determining factors for caesarian section delivery (Oliver, 2000). If placenta previa is diagnosed at the twentieth week and the mother is not experiencing a great deal of bleeding, she may be advised to cut back on her activities and increase her rest time. A mother may also be advised to refrain from any form of sexual intercourse.
A mother is advised to refrain from these activities because most of the placenta previas tend to resolve with time. Transfusion is considered a beneficial medical intervention in case a mother is experiencing severe vaginal bleeding. Steroids may also be administered through injection in order to speed up maturation of the lungs of the fetus. The main aim of these treatment modalities is to keep the mother and the developing fetus in a stable condition until at least thirty six weeks; the point at which the baby may be delivered through caesarian section in order to minimize excessive bleeding (Jocoy, 2010).
Caesarian section is carried out at a gestational stage when it would result in reduction of the risk of hemorrhage that may arise from normal uterine contractions that occur at the beginning of labor. It is also carried out when the likelihood of fetal maturity is high. Hemoglobin levels of mothers presenting with placenta previa is closely monitored and transfusion carried out if anemic conditions are detected. Conclusion It can therefore be concluded that placenta previa is a rare, but serious complication that occurs during pregnancy and results in excessive loss of blood either during or before delivery.
The placenta is a very helpful organ that provides the developing baby with oxygen and nutrients in addition to removal of waste products. It is a vital link between the mother and the developing fetus. Complications affecting this organ can therefore have devastating effects to the pregnant mother and the developing baby. Inappropriate attachment of the placenta on the uterine wall results in placenta previa. Placenta previa is a rare complication that occurs during pregnancy, which results in excessive bleeding before, during or after delivery.
A major knowledge gap that exists in this issue concerns the cause of placenta previa. The main cause of placenta previa is not yet known. However a variety of factors including previous caesarian section, multiple pregnancies, smoking, consumption of cocaine, advanced maternal age, previous abortion abnormally developed uterus are believed to increase the risk of placenta previa. There are numerous adverse complications associated with placenta previa. These include: placenta abruptio, anemia and decrease in total maternal blood volume.
Premature delivery as a result of placenta previa may result in respiratory distress syndrome. Diagnosis of placenta previa is carried out using ultrasound scanning. Nursing care specific to clients presenting with placenta previa comprises of: examination for signs and symptoms of vaginal bleeding, laboratory tests, client psychological education, in addition to supportive care. In early stages of pregnancy, placenta previa may correct itself without any medical intervention as a result of the enlargement of the uterus.
Transfusion is considered a beneficial medical intervention in case a mother is experiencing severe vaginal bleeding. Steroids may also be administered through injection in order to speed up maturation of the lungs of the fetus. Reference: Amy M. Romano (n. d). Research Summaries for Normal Birth, Journal of Perinatal Education, Vol. 15: 3 Azziz R. , (2006), Obstetrics and gynecology: cases, questions, and answers, ISBN 0071458204: McGraw-Hill Professional, Buckley S. , (2003), Undisturbed Birth: Nature’s Blueprint for Ease and Ecstasy, Journal of
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